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Lariann S Ross

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NPI Number Detailed Information

Provider Information:

Name: Lariann S Ross
Gender: F
Provider License Number If Given: R100155

NPI Information:

NPI: 1003815523
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 7/18/2005

Last Update Date: 9/15/2010

Provider Business Mailing Address:

Address: 1061 HARMON AVE DMC/IMC
Fort Stewart, GA 31314
Phone Number: 9124355706
Fax Number: 9124355569

Provider Business Practice Location Address:

Address: 1061 HARMON AVE DMC/IMC
Fort Stewart, GA 31314
Phone Number: 9124355706
Fax Number: 9124355569

Provider Taxonomy:

Primary: 363LF0000X
Secondary (if any): 363LF0000X
State: GA

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